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Full text of "United States Navy Medical News Letter Vol. 34 No. 9, 6 November 1959"

NavMed 369 




UNITED ST ATES NAVY 



.GamDo©aiL ::rmsw8© tssms 



Rear Admiral Bartholomew W. Hogan MC USN - Surgeon General 
Captain Donald R. Childs MC USN - Editor 



Vol. 34 



Friday, 6 November 1959 



No. 9 



TABLE OF CONTENTS 



Historical Fund of the Navy Medical Department 



ABSTRACTS 

Diet and Atherosclerosis in Orient . . 3 

Management of Pericarditis 5 

Carcinoma of the Prostate 7 

Perfusion Techniques in Cancer ... 9 

Treatment of Appendicitis 11 

Gastric Cooling in Peptic Ulcer . . . 12 

MISCELLANEOUS 

Research and the Practitioner ... .14 
Building for Radiation Evaluation. .16 
Training in A B C Warfare Defense . . 18 
From the Note Book 19 

DENTAL SECTION 

Heterogenous Anorganic Bone .... 20 
Role of Dentists in Civil Defense . 20 



DENTAL SECTION (continued) 
International Guests at NDS . . . 
Exhibit at Dental Congress .... 
Personnel News 



22 
22 
23 



24 
25 



RESERVE SECTION 

Transfer to Retired NR .... 
Qualifications Questionnaire 

PREVENTIVE MEDICINE 



Eastern Equine Encephalitis .... 26 

Influenza 1959 - I960 27 

Control of Schistosomiasis 28 

Disease Vector Control Training 30 

Food Establishment Sanitation . . 33 

Rules for Turnpike Driving 37 

Diarrhea of Travelers 38 

Revision in Travel Immunization . 38 



SPECIAL NOTICE 39 



Medical News Letter, Vol. 34, No. 9 



HISTORICAL FUND 

of the 
NAVY MEDICAL DEPARTMENT 



A committee has been formed with representation from the Medical 
Corps, Dental Corps, Medical Service Corps, Nurse Corps, and 
Hospital Corps for the purpose of creating a fund to be used for the 
.collection and maintenance of items of historical interest to the Medical 
Department. Such items will include, but will not be limited to, por- 
traits, memorials, etc. , designed to perpetuate the memory of dis- 
tinguished members of the Navy Medical Department. These memorials 
will be displayed in the Bureau of Medicine and Surgery and at the 
National Naval Medical Center. Medical Department officers, active 
and inactive, are invited to make small contributions to the fund. It is 
emphasized that all donations must be on a strictly voluntary basis. 
Funds received will be deposited in a Washington, D. C. bank to the 
credit of the Navy Medical Department Historical Fund, and will be 
expended only as approved by the Committee or its successor and for 
the objectives stated. 

It is anticipated that an historical committee will be organized at each 
of our medical activities. If you desire to contribute, please do so 
through your local historical committee or send your check direct, 
payable to Navy Medical Department Historical Fund," and mail to: 

Treasurer, N.M.D. Historical Fund 
Bureau of Medicine and Surgery (Code 14} 
Department of the Navy 
Washington 25, D. C. 



Committee 

F. P. GILMORE, Rear Admiral (MC) USN, Chairman 
C. W. SCHANTZ, Rear Admiral (DC ) USN 
L. J. ELSASSER, Captain (MSC) USN 
R. A. HOUGHTON, Captain (NC) USN 
T. J. HICKEY, Secretary-Treasurer 



Medical News Letter, Vol. 34, No. 9 



Diet and Atherosclerosis in the Orient 

The best hope to arrest, retard, or prevent atherosclerosis lies in 
discovering the reasons for geographic, ethnic, and constitutional variations 
in frequency and degree of the disease. 

Many countries either lack statistics or have statistics that are not 
reliable. Results of medical and anatomic surveys from the same area are 
apt to differ. Limitations of morbidity statistics are obvious. Mortality sta- 
tistics are worthless unless they are based on necropsy data. The International 
List of Causes of Death and the currently used death certificates hinder rather 
than further the epidemiologic study of atherosclerosis. 

The author visited Bangkok, Thailand, Hong Kong, and many cities in 
Japan, making an analysis of the nutrition pattern of the average population. 

Japan has a rather uniform population, which is also uniform in regard 
to diet. Differences are quantitative rather than qualitative. The average daily 
intake is 2,104 calories. Fat provides an average of 8. 6% of all calories, while 
proteins contribute 12. 8%, and carbohydrates 78. 8%. The average daily fat con- 
sumption is 20 grn. , protein 77 gm. , and carbohydrates 411 gm. 

The fats most used are sesame oil, containing about 87% unsaturated fatty 
acids; soybean oil, containing an average 86. 6%; and peanut oil, with 82. 9% 
unsaturated fatty acids. The linoleic acid content of the three oils is 21, 51. 2 
and 29%, respectively. The ratio of linoleic acid to saturated fatty acids is 
1. 6, 3. 9 and 1. 7, respectively. 

Total fat consumption is low, total protein intake is not high. Two-thirds 
of the protein comes from fish and vegetables, while only one-third is obtained 
from meat. On such diet the Japanese are lean. The average Japanese is not 
undernourished, but he is somewhat less than "well nourished. " 

Cardiovascular disease occurred in 14. 5% of all hospital patients in 1954, 
Today, the figure undoubtedly is higher. Since 1936, the incidence of angina 
pectoris, myocardial infarction, and renal and cerebrovascular diseases has 
been steadily rising. The ascending curves were slightly disturbed by a drop 
in frequency during the war years, 1942 - 1945, and into the following year. 
Since 1949, the increase has been steady and marked. Curves for anginal 
symptoms, whether spontaneous or elicited by effort, and for myocardial infarc- 
tion run parallel. 

The incidence of cerebral hemorrhage is twice that encountered in North 
America and is more frequent than myocardial infarction. Hypertension, as 
such, also is more common in Japan than in the United States. Clinical data 
are matched by anatomic data. Both types were collected by members of a 
special Committee of the Ministry of Education. 

In 1955, the death rate from heart disease was 64. 4%. The ratio of 
males to females was about the same as in America as far as myocardial in- 
farctions and atherosclerosis are concerned. Positive correlation of the 
degree of atherosclerosis between coronary arteries and aorta is close to 80%. 



Medical News Letter, Vol. 34, No. 9 



Coronary disease appears earlier or at the same time as aortic disease. 
Basilar and renal artery disease develops later and more slowly than that of 
coronary arteries. 

Thailand presents a different picture than Japan — statistics are confus- 
ing and the population lacks the ethnic uniformity of Japan. From various 
statistical reports, fat consumption ranges from 28 to 42 gm; protein, 47 to 
60 gm. ; and carbohydrate, 208 to 420 gm. Correlation of diet with health 
has not been possible to date because of refusal of physical examination by 
the populace. 

Lard is the main source of fat {43% saturated fatty acids). Some coco- 
nut oil is used, with about 91. 2% saturated fatty acids. The linoleic acid 
content of lard is 10%, that of coconut oil only 2%; the ratio of linoleic acid 
to saturated fatty acid is 0. 23 for lard to 0. 02 for coconut oil. 

While there are no statistics concerning the incidence of atherosclerosis, 
the rarity of clinical disease is pointed out by all physicians of Thailand. Clin- 
icians can count on their fingers the number of patients with myocardial infarc- 
tion or angina pectoris. Myocardial infarction is a rare postmortem diagnosis. 
The aortae appear "younger" at necropsy than those of Americans of corres- 
ponding age. Complicated atherosclerotic lesions are seen in the aged only. 

The low incidence of atherosclerosis is even more surprising when one 
learns that diabetes mellitus is common. Physicians encounter the renal 
complications of diabetes, but not those in other sites. It was not ascertained 
whether diabetics develop hypercholesteremia, nor was blood cholesterol of 
nondiabetics determined. Hypertension is common, occurring in 6 to 7% of 
hospital patients in 1954 - 1955. Necropsy findings seem to support clinical 
observations. 

Atherosclerosis does not constitute a problem in Thailand, for the 
present at least. Published data are available, but interest in the subject is 
limited, and research is limited by lack of facilities and personnel. 

Japan and Thailand represent two extremes. According to prevailing 
concepts, the Japanese diet can be labeled "antiatherogenic" while the diet in 
Thailand can be labeled "atherogenic. " The Japanese diet is low in calories, 
fat, and cholesterol. Fried food is rare. The fat used is rich in linoleic acid 
and other unsaturated fatty acids. The diet in Thailand is rich in fat and cho- 
lesterol. Fried food is common and all food is greasy. The fat used contains 
little linoleic acid and few other unsaturated fatty acids. Atherosclerosis is 
common in Japan and rare in Thailand. 

"Evidence to support the concept that high levels of plasma cholesterol, 
per se, in man are atherogenic is far from conclusive. Circumstantial evi- 
dence, however, indicates that the kind or amount of dietary fat is in some way 
related to some stage of atherosclerosis in man. A reduction in intake of the 
more saturated fats in the diet may ultimately prove desirable for health, but 
is not yet mandated by currently available evidence. " This cautious statement 
by the Food and Nutrition Board of the National Research Council may have to 



Medical News Letter, Vol. 34, No. 9 



undergo revision. (Pollak, O, J. , Diet and Atherosclerosis: Am, J. Clin. 
Nutrition, 7j 502-507, September - October 1959) 

Current Aspects of Management of Pericarditis 

Acute pericarditis continues to present a challenge to the clinician from 
the viewpoint of etiology and differential diagnosis as well as treatment. 

Occurring in the course of myocardial infarction, neoplastic disease, 
and advanced renal disease with uremia, acute pericarditis may be accepted 
as directly related to these disorders. However, it poses an etiologic and 
differential diagnostic problem when encountered not only in the so-called 
idiopathic or nonspecific form, but even in the case of so-called rheumatic or 
primary tuberculous pericarditis. Clinically, these three types of pericarditis 
markedly resemble each other. Considerable difference in treatment and prog- 
nosis is apparent. 

At times, the clinical picture of pericarditis resembles closely that of 
acute myocardial infarction. Whether it occurs in a person of middle age or 
older, the differential diagnosis bears greatly upon the immediate and long- 
term management. 

Dissatisfaction with laboratory procedures currently available for diag- 
nostic differentiation has prompted a search for additional laboratory aids. 
Of these, the fibrinogen polymerization (FP) test of Losner and Volk holds 
particular promise. Having noted its highly specific nature in active rheuma- 
tic fever and arthritis, the authors explored its usefulness in pericarditis and 
found it to be positive in a preliminary group of patients with acute rheumatic 
and nonspecific pericarditis. They have since followed 20 patients with peri- 
carditis by systematic serial studies of the FP test as well as the conventionally 
used acute phase reactants, including the C -reactive protein (CRP), erythrocyte 
sedimentation rate (ESR), plasma fibrinogen concentration, and antistrepto- 
lysin-O (ASO) titer. In cases where myocardial infarction must be considered, 
the serum GO -transaminase test was also employed. 

Initial determination of the FP test gave consistently positive results in 
the acute phase of nonspecific pericarditis, correlating well with the uniformly 
accelerated ESR and plasma fibrinogen concentration, but poorly with the CRP 
and ASO titer. The FP test was positive also in acute rheumatic pericarditis. 
It correlated well with the ESR, CRP, and plasma fibrinogen concentration, 
but poorly with ASO titer. In the presumably tuberculous group, the FP test 
was negative as were all other tests except the ESR. 

In serial determinations extending over a period of up to 12 months, the 
FP test reflected closely the clinical course of idiopathic pericarditis and 
rheumatic fever. Also, there was close correlation between the FP test and 
ECG changes. Furthermore, it was noted that the FP test remained positive 



Medical News Letter, Vol. 34, No. 9 



until all clinical manifestations of activity of the disease disappeared, while 
the acute phase reactants usually reverted to normal at an earlier date. In 
several instances when the FP test remained positive for a prolonged period, 
recurrence of acute pericarditis was observed and with it a return to abnormal 
of the acute phase reactants. 

In contrast to the nonspecific acute phase reactants, the FP test was not 
affected by steroid therapy. Results observed by the authors seem to confirm 
the value of the FP test as a useful aid (1) for diagnosis of the nonspecific 
variety of acute pericarditis, (2) for evaluation of continued activity of the 
disease, and (3) for determination of efficacy of treatment. 

In so-called rheumatic pericarditis, the doubt appears to be justified 
whether cases of isolated pericarditis are truly rheumatic in nature when they 
occur in patients with a history of rheumatic fever or when they present the 
findings of inactive rheumatic valvular disease. Clinically, this appears cer- 
tain only in the presence of simultaneous rheumatic myocarditis, endocarditis, 
or other associated major manifestations of acute rheumatic fever. 

The fact that the FP test is positive in the acute phases of all observed 
cases of nonspecific and rheumatic pericarditis, and reflects the course of 
this disease as consistently as it does in active rheumatic fever with and 
without carditis suggests an underlying mechanism common to both conditions 
which interferes with the normal polymerization process of fibrinogen. 

Complete studies in relationship to the significance of the FP test in 
patients with tuberculous pericarditis are not available. However, observa- 
tions suggest that a negative FP test may help rule out acute rheumatic or 
nonspecific pericarditis, but is of no significance in relation to tuberculous 
pericarditis. 

The problem of differentiation of pericarditis from myocardial infarc- 
tion may be solved by the combined use of the FP test and serum enzyme 
determination. This problem is particularly acute when the ECG fails to show 
the pattern of a typical transmural infarction. 

Treatment of nonspecific pericarditis is difficult to evaluate. Equivocal 
results have been reported not only with salicylates, but also with a number of 
antibiotics, alone or in combination. In more severe cases, prompt adminis- 
tration of steroids has proved most efficacious, although not necessarily pre- 
venting recurrences. 

After institution of a regimen, prompt improvement of symptoms and 
restoration of normal temperature usually follows in 24 to 48 hours. Within 
a short period, acute phase reactants also return to normal. The FP test 
remains positive for a longer period. Discontinuance of steroids at this point 
leads to a quick relapse. Only when the FP test has turned negative and re- 
mains so for at least two weeks is it advisable to reduce steroids in the 
manner usually recommended for a high dosage regimen. 

Observations of the authors on treatment of so-called rheumatic peri- 
carditis confirm the adequacy of salicylate therapy in most cases. Steroid 



Medical News Letter, Vol. 34, No. 9 



administration may be required in certain selected cases. Again, the FP test 
is a reliable guide to therapy. 

In cases where tuberculous etiology cannot be ruled out with certainty, 
the advisability of steroid therapy may be questioned. Some observers have 
reported that cortisone treatment does not prevent the early onset of constric- 
tive pericarditis. Prophylactic use of isoniazid is advisable in cases of non- 
specific pericarditis where there is reasonable suspicion of a tuberculous cause. 
(Fremont, R. E. , Volk, B. W. , Newer Aspects of Diagnostic and Therapeutic 
Management of Acute Idiopathic Pericarditis: Dis. Chest, XXXVI : 319-327, 
September 1959) 

Carcinoma of the Prostate 

Appreciation of the comparatively high incidence of occult carcinoma of 
the prostate gland in elderly men has stemmed from the observations of Muir, 
Rich, and Moore. In Rich's cases, the lesions were found for the most part 
located beneath the capsule in both lateral and posterior lobes, while in 
Moore's investigation almost three-fourths of the neoplasms were located in 
the posterior aspect of the gland. The predilection for posterior localization 
was substantiated by Gaynor. Kahler, on the other hand, found more lesions 
originating in the lateral lobes. An indication of multicentricity of origin was 
provided by Moore who observed 68 neoplastic foci in 52 prostate glands con- 
taining small carcinomas. Gaynor and Kahler also described multiple sites 
of origin. 

The authors' study was designed to investigate by means of large tissue 
sections the frequency with which occult carcinoma arises simultaneously in 
multiple portions of the prostate gland and to plot the distribution of these 
lesions. An ancillary purpose was investigation of enzymatic activity of neo- 
plastic and non-neoplastic prostatic epithelium by histochemical means. 

At the Cincinnati General Hospital, 225 prostate glands were secured at 
necropsy from men over 50 years of age. No selection was made except for 
the exclusion of all cases in which a diagnosis of prostatic carcinoma had been 
made before death. 

Among the 220 glands examined, 7 carcinomas, unsuspected clinically, 
were recognized grossly by the prosectors. Among the 213 remaining glands 
in which no gross evidence of neoplasm was detected, 64 (30%) were found to 
contain one or more foci of carcinoma when surveyed microscopically. Exam- 
ination of a single transverse section was the rule; no effort was made to 
examine several sections. In 40 (56.4%) only a single neoplastic lesion was 
detected; in 26 {36. 6%) there were multiple lesions, and in 5 (7. 0%) the entire 
section was diffusely affected. Undoubtedly, examination of multiple sections 
would have increased the yield of multicentric carcinomas. 



Medical News Letter, Vol. 34, No. 9 



Due to multiple lesions there was lateral lobe involvement in 89.1% of 
cases and posterior lobe involvement in 33.3%. 

Review of 17 standard reference works in urology, pathology, and neo- 
plastic disease reveals that all call attention to the great frequency of carci- 
noma of the prostate in elderly men. In 14 of the references the cancer is 
described as originating predominantly in the posterior lobe while the occur- 
rence of multicentricity is not mentioned. The latter condition appears to 
warrant greater emphasis in view of the frequency with which it has recently 
been noted in the literature, and confirmed by the present investigation. In 
this study, among 66 examples of carcinoma in which the entire gland was 
not affected, 107 separate sites of carcinoma were encountered. The frequency 
with which three and more foci were identified in a single gland is especially 
noteworthy and may offer a clue in explanation of diffuse glandular involvement 
which is observed with such high frequency in cases of clinically overt prosta- 
tic cancer. 

The predilective localization of early carcinoma of the prostate shown by 
the authors is at variance with that of most other reports which locate the 
lesion in the posterior lobe more than elsewhere. Actually, there is consider- 
able evidence to indicate that no sharp demarcations exist between the 'lobes'' 
of the prostate and what appears to be posterior lobe in one plane may appear 
to be lateral lobe in another. Some authors advocate abandonment of the 
allegedly artificial division of the gland into lobes, substituting a zonal division 
into central, middle, and peripheral regions, with neoplasms predominating in 
the last location. At all events, it should be recognized that the majority of 
prostatic carcinomas probably do not arise or present posteriorly. This 
observation should serve to reduce the sense of security conveyed to the phys- 
ician by the absence of nodulation or induration on rectal examination or the 
absence of carcinoma on needle biopsy of the posterior portion of the prostate. 

On histochemical study, neoplastic acini generally manifested activity 
similar to that of normal acini, but with seemingly greater intensity because of 
the concentrations of neoplastic elements. Total disorganization of prostatic 
architecture in zones of neoplastic alteration was clearly revealed in sections 
prepared to demonstrate enzymes. (Butler, J., et al. , Incidence, Distribution, 
and Enzymatic Activity of Carcinoma of the Prostate Gland: A. M. A. Arch. 
Path. , 68: 243-251, September 1959) 

5p & t< & ^ ^ 

Change of Address 

Please forward requests for change of address for the News Letter to: 
Commanding Officer, U. S. Naval Medical School, National Naval Medical 
Center, Bethesda 14, Md. , giving full name, rank, corps, and old and new 
addresses. 



Medical News Letter, Vol. 34, No. 9 



Treatment of Cancer of the Extremities 
by Perfusion Techniques 

In order to improve life expectancy and obtain better palliation in the 
treatment of malignant disease, emphasis has recently been directed toward 
the use of chemotherapeutic agents. In general, cancerocidal drugs have 
been used as adjuvants to palliation in extensive regional or disseminated 
malignant conditions. The limiting factor to the use of chemotherapy, how- 
ever, has been the toxic effects on bone marrow and the gastrointestinal tract. 
In an attempt to limit these systemic toxic effects and obtain the benefit of in- 
creasing dosage, a method has been developed whereby the tumor -bearing 
area could be temporarily isolated and perfused by utilizing a pump -oxygenator. 

Methods were developed in the laboratory for the isolation and perfusion 
of the extremities, mid-gut, and liver in the experimental animal. These pro- 
cedures also have been applied clinically for perfusion of the extremities, lung, 
breast, pelvis, oropharynx, and total body. To date, 73 cases have been 
treated by this method, including the patients of the current report. Perfusion 
of the lower extremity is accomplished through the external iliac, the common 
femoral, or the superficial femoral vessels, depending upon the location of the 
tumor. In the upper extremity, the subclavian, axillary, or brachial vessels 
are used. 

Techniques and dosages employed in perfusion of the extremities are 
described and tabulated. The lower extremity, perfused through the common 
femoral artery, will tolerate the usually recommended systemic dose. This 
represents a six to eightfold increase in concentration of the drug since the 
lower extremity constitutes one -sixth or less of the total body mass. Animal 
experiments suggest that the amounts of chemotherapeutic agents may be 
increased beyond the limits described, and in recent clinical experience this 
has been done without apparent increase in toxic effects. 

The current report which includes only perfusion of an extremity lists 
45 perfusions performed in 3 7 patients, including 17 with malignant melanoma, 
17 with some type of sarcoma, and 3 with primary or metastatic carcinoma of 
the extremity. 

The authors acknowledge that at present it is impossible to evaluate the 
results of treatment in these patients because of the short time the study has 
been in progress. An attempt has been made to determine the present status 
of each patient, the fact being kept in mind that their status is constantly 
changing. 

Among the 17 patients with malignant melanoma, 14 had disease confined 
to the lower, and 3 to the upper, extremities. Of 13 patients treated for pal- 
liation, 3 are dead. Two of these had the local tumor controlled by perfusion, 
but subsequently died of distant metastases. Among the 10 patients still living, 
3 have recurrent disease, and 7 are considered to be in a quiescent stage. It 
must be emphasized that this group is composed of patients with far advanced 



10 Medical News Letter, Vol. 34, No. 9 



but regionally confined disease which, if treated conventionally, would require 
radical amputation. 

Twenty perfusions have been carried out in 17 patients with sarcoma of 
the extremities. In 10 the lesions were confined to the lower extremity and 
in 7 to the upper extremity. Of the 4 patients in whom perfusion was used as 
an adjunct to surgical excision, one is dead, in another the lesion recurred 
and is quiescent after retreatment, and in 2 the disease appears to be con- 
trolled. Of the 13 treated for palliation, 5 are dead. Among the living patients 
4 have had varying degrees of regression of their tumors with subsequent 
recurrence, while in one the lesion is quiescent and in 3 the lesions are con- 
trolled. 

Relatively few patients with carcinoma of the extremities have been 
treated by this method. 

Local complications in the extremities have been relatively minor. 
There has been no evidence of arterial or venous thrombosis and edema of the 
extremity has not been a serious problem. When the dosage has been high, 
intense erythema of the skin has occurred followed by brawny edema similar 
to that observed following x-ray therapy. The administration of cortisone 
seems to speed resolution of this process. 

Systemic complications have been minimal following isolated perfusion 
of the extremities. The amount of nausea or vomiting immediately following 
the operative procedure has been no greater than that seen after general 
anesthesia. Depression of bone marrow has been a problem in some cases; 
however, if isolation is adequate the depression has been minimal. Usually, 
all elements are depressed, but the white blood cell count is the easiest and 
most reliable to follow. 

It should be emphasized that the tumors included in this series do not 
respond ordinarily to conventional methods of chemotherapy or irradiation. 
Thus, it can be assumed that the response observed in many of these patients 
was the result of the isolation -perfusion technique. 

At present, an attempt is being made to improve the results by using 
combinations of drugs rather than a single agent. Attempts also are being 
made to improve the selection of more specific chemotherapeutic agents. 
Studies are under way to develop a sensitivity test. 

Although there are many possible uses for the techniques of perfusion, 
the principal concern is the evaluation of highly toxic agents whose therapeutic 
usefulness is limited by their toxicity. (Krementz, E. T. , et al. , Treatment 
of Malignant Tumors of the Extremities by Perfusion with Chemotherapeutic 
Agents: J. Bone & Joint Surg. , 41-A : 977-987, September 1959) 

NOTE: A report by R. C. Hickey, et al. , in the September A. M. A. Archives 
of Surgery describes extracorporeal pump perfusion of radioactive isotopes 
and nitrogen mustard as adjuncts to external radiation therapy and analyzes 
results in five adults with advanced cancer of the lower extremities. 



Medical News Letter, Vol. 34, No. 9 11 



Conservative Treatment of Acute Appendicitis 

In the years preceding 1953, most patients with acute appendicitis and 
abscess formation were treated conservatively in the surgical clinic of the 
author at Rotherham Hospital (England). The results were so satisfactory 
that with the advent of a wider range of antibiotics, subsequent patients with 
acute appendicitis and without abscess formation were treated conservatively. 

The 5 years under review, 1953 - 1957, fell into three phases. The first 
phase was from 1953 to 1955 when all patients with acute appendicitis of longer 
than 24 hours' duration were treated conservatively. During 1956, the second 
phase, all patients with acute appendicitis were treated conservatively. In any 
case in which the disease recurred after conservative treatment, appendectomy 
was performed. All patients were advised to have an interval appendectomy. 
The third phase was in 1957. During this year all patients with acute appen- 
dicitis were treated conservatively. In any case of recurrence of acute appen- 
dicitis after conservative treatment, appendectomy was done. No interval 
appendectomy was done except at the request of the patient, the patient's 
parents, or the family physician. 

Treatment given is rest in bed in any position the patient finds comfort- 
able; nothing by mouth except water which is given freely; 6-hour injections of 
penicillin, 250,000 units, with streptomycin, 0. 5 gm. In cases of severe 
involvement, chloramphenicol, oxytetracycline, or other antibiotics may also 
be given. Pain is relieved by Pethidine and/or morphine, but usually little is 
needed after the first 24 hours. If vomiting is marked, gastric suction is 
instituted, intravenous infusions are given, and total daily fluid intake and 
output are carefully balanced. 

When pain and sickness have subsided and temperature and pulse have 
fallen, dextrose, milk, and other fluids are given by mouth. There is a 
gradual return to normal diet, varying in time according to the severity of the 
attack. No purgatives or enemas are given. Liquid petrolatum, 15 ml. night 
and morning, is given by mouth. As the condition subsides, a glycerin sup- 
pository is used if necessary. 

In cases of appendiceal abscess the same treatment is given, resolution 
usually occurring. If this does not happen, a waiting policy is adopted until 
the abscess either presents at the anterior abdominal wall or can be palpated 
rectally as a bulge in the pelvis. In the former case, when the percussion note 
is dull, the patient is placed under general anesthesia and wide-bore needle 
is passed through the abdominal wall until pus can be aspirated. A stab inci- 
sion is made with a scalpel along the needle, a large artery forceps is used to 
enlarge the stab, the pus is evacuated, and a small drainage tube is inserted. 
When a bulge in the pelvis is palpated rectally, the sphincter ani is dilated 
under anesthesia and the abscess is opened with a sharp-pointed sinus forceps 
at the point of fluctuation. No drainage is necessary. 

During the first phase, 137 patients with acute appendicitis of more than 
24 hours were treated conservatively with one death — that of a man aged 78 



12 Medical News Letter, Vol. 34, No. 9 



who seemed to recover from appendicitis, but died from complications of 
cardiac failure and pneumonia. During the second phase, 163 patients with 
acute appendicitis were treated conservatively with no deaths. Acute appen- 
dicitis recurring after conservative treatment was treated by appendectomy; 
there were 22 recurrences without any deaths. Forty-three underwent inter- 
val appendectomy without any deaths. During the last phase, 171 patients 
with acute appendicitis were treated conservatively, again with no deaths. 
Recurrent acute episodes developed in 26 who underwent surgery without any 
fatalities. Nine interval appendectomies were performed successfully. 

Perhaps the most important advantages of conservative treatment are 
low mortality and morbidity. Confidence in conservative treatment permits 
observation and time for investigation and consultation. This automatically 
leads to fewer mistakes in diagnosis and treatment. Many conditions may 
make conservative treatment and postponement of operation desirable. If 
appendectomy is to be done, it is better done during a quiescent period, 
resulting in minimal postoperative risks. The advantage most appreciated 
by the patient is the avoidance of a surgical operation. 

Perhaps the most important disadvantage is the difficulty of diagnosis. 
In most cases, a clear-cut diagnosis can be made and no difficulty exists. 
Another disadvantage may be in the economic field. However, the ultimate 
aim is the good of the patient, and undue weight should not be given to econo- 
mic considerations. A patient with acute appendicitis treated conservatively 
nearly always can be restored to normal as quickly as by operation — if not 
more quickly. Especially in cases of recurrent appendicitis, there is eco- 
nomic loss of the patient's time and of hospital bed space. Even in these 
cases, the author continues to give conservative treatment. (Coldrey, E. , 
Five Years of Conservative Treatment of Acute Appendicitis: J. Internat. 
Coll. Surg., 32: 255-261, September 1959) 



Gastric Cooling in Management of Peptic Ulcer 

At the University of Minnesota Medical Center, for a period of one year, 
the authors have employed the technique of local gastric cooling in the control 
of massive gastric hemorrhage. Their experience to date affirms the belief 
that this procedure possesses merit, but it is apparent that further experience 
is required to learn precisely what some of the advantages and disadvantages 
may be. 

One of the important items concerning which prompt decision is neces- 
sary is whether early operation should be undertaken as soon as the vital signs 
have become stabilized and bleeding has stopped, following initiation of local 
gastric cooling. Also, (1) will local gastric cooling alone suffice? (2) Should 
the patient be taken directly to the operating room with the cooling device in 



Medical News Letter, Vol. 34, No. 9 13 



situ as soon as vital signs are stabilized? (3) Should there be a delayed 
operation? 

Experience of the authors provides only incomplete answers. In bona 
fide peptic ulcers, duodenal or gastric, control of the bleeding has usually 
sufficed. However, in steroid induced ulcers and those following severe bodily 
insults, recurrence of bleeding has been frequent enough to suggest the neces- 
sity of operative intervention as soon as bleeding comes under control. Sim- 
ilar experience with hemorrhagic gastritis is reported. 

Studies upon man and dog, employing local gastric hypothermia, indicate 
that gastric digestion is virtually suspended at temperatures of 10 to 14° C. 
Additional evidence has been gained for the conclusion that pepsin is primarily 
the active proteolytic factor surpressed by cooling. 

Earliest observations were made employing cooling through a gastric 
balloon. Studies were made to ascertain whether gastric cooling might be 
achieved by simply perfusing the stomach directly with a solution continuously 
circulated through a double lumen tube. Results indicated that the method was 
practical, and that the inflowing cooling solution could be several degrees above 
the freezing point. The ideal agent with which to perfuse the gastric mucosa 
remains to be determined. 

This report details the results of treatment of 30 patients with massive 
gastrointestinal hemorrhage. In all cases, the diagnosis of active bleeding 
was established by aspiration of bright red blood through a nasogastric tube 
and by evaluation of history, physical signs, and previous blood replacement. 
Normal rectal temperature was maintained by peripheral warming of the patient, 
while cooling was accomplished by techniques previously reported. 

Eleven patients were bleeding from duodenal ulcer. At the institution of 
gastric cooling, three-fourths of these patients were in shock. Prompt and 
permanent cessation of bleeding occurred in all instances within 3 to 6 hours 
after institution of local hypothermia. Three other patients, bleeding from 
duodenal ulcer, were treated. Their bleeding was acute, following marked 
stress or prolonged steroid therapy. In these patients, massive bleeding 
recurred within 2 to 5 days following the fir st successful treatment. Recooling 
of 2 of them resulted in complete cessation with no further hemorrhage. 

Two patients were treated for massive hemorrhage from gastric ulcer. 
One stopped bleeding within a short time and required no further treatment. 
The other had an antral lesion which appeared to be malignant. Therefore, 
after 3 hours of cooling, when hemorrhage appeared to be controlled and 
blood loss replaced, the lesion was removed surgically and proved to be 
benign. Both patients were alive and well at the time of the report. 

Five patients have been treated for bleeding esophageal varices. Control 
of hemorrhage was successful in 3 patients who subsequently underwent sur- 
gery. Two patients died, one despite control of hemorrhage by hypothermia, 
and the other in early postoperative period when bleeding failed to be con- 
trolled by the technique. The cause of bleeding in 2 patients was hemorrhagic 



14 Medical News Letter, Vol. 34, No. 9 



gastriti-s. Both responded to local gastric hypothermia with complete cessa- 
tion of hemorrhage. However, bleeding recurred within Z4 hours and both 
underwent an immediate definitive surgical procedure. One patient died late 
in the postoperative period from cardiac complications but without further 
hemorrhage. 

Cooling of the stomach retards and virtually inhibits active gastric 
digestion. This effect is primarily due to: (1) depression of peptic activity, 
(2) suppression of gastric secretion; and (3) diminished blood flow. At the 
temperature of the cooled stomach, peptic activity is essentially suspended, 
gastric secretion is diminished 75% or more, and gastric venous outflow, 
which undoubtedly reflects arterial inflow, is decreased approximately 66%. 

The volume and proteolytic activity of gastric juice appears to rebound 
following cooling, a circumstance which suggests definitely the need for early 
operation if the intragastric or intraduodenal infusion of a continuous cold 
skim milk drip initiated immediately and administered through an indwelling 
nasogastric tube, fails to control the situation. (Wangensteen, O. H. , et al. , 
Studies of Local Gastric Cooling as Related to Peptic Ulcer: Ann. Surg., 
150: 346-360, September 1959) 



Experience in Research - 
Its Value to the Practicing Physician 

There is no need to document the value of medical research as a major 
factor in the constantly improving well-being of mankind. It could be con- 
vincingly contended that knowledge of health and the control of disease have 
progressed farther in the last 50 to 60 years than in all the preceding ages 
of man. 

Furthermore, it is unnecessary to declare the value of participation 
in research for a medical student who anticipates a career of either full-time 
investigation or part-time clinical research supplementing the practice of 
medicine. 

It is self-evident that research must continue to increase the under- 
standing of man in health and disease, and that participation in it. must begin 
at an early stage in the education of the physician who intends to pursue fur- 
ther research. Some training in research can contribute markedly to the 
education of a physician who is engaged entirely in clinical responsibilities, 
as is necessarily the case with most physicians. Research experience of a 
physician who soon will become fully engaged in clinical practice sharpens 
his judgment and enhances his evaluation of the research of others. 

Research has been called "a way of making nature talk. " But nature 
guards her secrets — is loath to speak. Research reveals the difficulty 
of discovery. Only the student or physician who has actually participated 



Medical News Letter, Vol. 34, No. 9 15 



in research is completely aware of the tremendous effort and patient toil 
exacted of the investigator. Characteristic of the unhasty pace of research 
discovery is the story of insulin, with the long and labored span of three 
decades between the experimental production of diabetes in dogs and the begin- 
ning of its control in man. 

Even though a physician may do no research or may engage in a limited 
specialty, his past research experience may provide a rewarding special 
interest. The postgraduate resident physician who spends only 3 to 6 months 
in a cardiac catheterization laboratory will be prompted to follow subsequent 
findings in this field with considerable gratification. 

Research develops an alertness to the apparently inconsequential. Inci- 
dental observations may prove to be far more important than the original goal 
sought in the experiment. Alertness to apparently insignificant detail has 
yielded many a discovery. Likewise, clinicians who rise above the common 
lot have become sensitive to the minute, the obscure, and the incongruent. 

Research provides lessons in teamwork which are equally necessary in 
clinical practice, particularly in dealing with complicated problems. The 
physician who does not learn this lesson of teamwork in the practice of med- 
icine and the employment of consultations by a collaborating group will be 
much less than a good physician. 

Research fosters a respect for persistent routine. Inspiration and 
glamour are not prominent in the constant plodding which is demanded. Re- 
wards of research or of medical practice demand countless inglorious hours 
of stubborn work as routine as may be found in the performance of many a 
less pretentious task than medicine. 

Research provides knowledge and familiarity with one of the highways 
of discovery. Study and reading essential in carrying out a research project 
are far different from the more casual reading of such material. 

Discovery following research is usually modest. Often it is a negative 
finding — the posting of a warning on a dead-end street. Yet it is a discovery, 
new knowledge, light in the darkness, a penetration beyond the frontier. Dis- 
covery, great or small, of what was never before known, is an adventure to 
be cherished, an experience likely to color a physician's entire outlook on 
his work. The physician who is imbued with the spirit of investigation aug- 
mented by research experience, will be a little more persistent in his diag- 
nostic searching s, therapeutic efforts, and self-evaluation. (Johnson, V. , 
Value of Research for the Graduate and Postgraduate Medical Student: 
J. A.M. A., 171:24-29, 5 September 1959) 

****** 

Use of funds for printing this publication has been approved by the 
Director of the Bureau of the Budget. (19 June 1958) 

****** 



16 Medical News Letter, Vol. 34, No. 9 



New Building for Radiation Exposure Evaluation 

RADM Bartholomew W. Hogan, Surgeon General of the Navy, has 
announced that final plans have been completed for construction of a new two- 
story Radiation Exposure Evaluation Building at the National Naval Medical 
Center, Bethesda, Md. Ground has been broken for this construction, and 
completion is scheduled for early in I960. The new building, covering 8,100 
square feet of floor space, will be the first of its kind for military usage and 
is considered another milestone in the progress of Navy Medicine. 

The primary purpose of the facility will be evaluation and treatment of 
persons suffering excessive radiation exposure, either accidentally or thera- 
peutically. However, in order to be prepared for handling any such potential 
future emergencies, other functions will be established which will further 
information that is already known relative to biologic and physiologic changes 
that occur following radiation exposure of varying degrees, and will provide 
for accumulation of data on which to base standards for determination of dos- 
age of exposure received. 

CAPT E, R. King MC USN, Chief of Radiology, U.S. Naval Hospital, 
and Director, Department of Nuclear Medicine, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Md. , stated that routine investiga- 
tional and clinical procedures will be carried out in the facility on a day-to-day 
basis. Such studies will include: evaluation of cases of certain hematologic 
dyscrasias and terminal cancer being treated by total body radiation or massive 
chemotherapy with or without marrow transplants; study of radiation therapy 
cases including metabolism, clinical pathology, histology, hematologic studies, 
and possibly chromotography of body fluids and special radioisotope studies; 
post-treatment care and management of patients receiving therapeutic doses 
of radioisotopes and radium; and special studies on persons exposed to, or 
possibly exposed to, ionizing radiation to include examination of the lens of the 
eye and sperm. Assisting in establishing pertinent studies and in care and 
management of patients receiving total body radiation therapy will be CAPT 
G. W. Hyatt MC USN, CDR W. McFarland MC USN, LT T.G. Hartney MC USN, 
and LT H. A. Pearson MC USN. 

The building will contain a receiving room where examinations may be 
carried out to determine the extent of the injuries of the patient. If the patient 
is contaminated with radioactive material; decontamination will be accomplished 
in specially designed spaces. A surgical room will be available in which minor 
surgery, debridement, first-aid, and other procedures may be carried out. 
Four low-background total body counters are planned for installation in special- 
ly constructed rooms where patients may be studied relative to the possibility 
of internally acquired radioactive materials. The counters are expected to be 
of value from a medico-legal aspect as well as to contribute immeasurably to 
the continued and expanding radio -biologic and nuclear medicine research prog- 
ram. The application of total body counting in clinical medicine wherein radio- 
isotopes are used is almost unlimited. 



Medical News Letter, Vol. 34, No. 9 17 



In addition to initial evaluation, other adjunctive facilities for care and 
study of patients will be provided in the new builc ^se will include 

hematology section where routine blood cell studi al investigational 

procedures, and bone marrow transplants may be shed as indicated. 

The radiohistology section will perform autoradiogi, idies as well as 

study activation analysis of tissues utilizing the nuclei tor that is now a 

part of the department. Chemistry laboratories will be jd for special chem- 
ical studies in addition to routine investigational procedures. The radioassay 
laboratory will provide for analysis of degree of radiation exposure of tissues 
and body fluids as well as breath samples. A plutonium analysis laboratory is 
currently in operation in the department, the functions of which will be expanded 
after the new building is completed. 

Three rooms have been designed for patient care. These will be "clean" 
rooms, with every attempt made to keep them in as near sterile conditions as 
possible for nursing care of patients who may have received high doses of 
ionizing radiation, either from an accidental exposure or in the form of therapy 
for an incurable cancer. Under circumstances of larger numbers of casualties, 
an attached temporary ward already existing will be available for care of greater 
numbers of patients. 

CAPT R. B. Williams MC USN, CAPT F. W. Chambers MSC USN, CDR 
G. JL. Lewis MC USN, and LT T. B. Mitchell MSC USN have assisted in the plan- 
ning of the facility. 

One of the interesting facets of the unique structure will be use of old 
8 -inch thick steel plates for radiation shielding in the counting chambers. 
Because environmental material in these chambers must necessarily be as 
free from radiation contamination as possible, it was necessary to locate steel 
that was fabricated before 1945, the time of the first atomic explosions. After 
considerable search for suitable material, old plates meeting specifications 
were obtained from a Naval Ordnance Depot in South Charleston, W. Va. 

Following completion, the new building, with its various facilities, com- 
bined with the work of personnel involved in the many facets of this rapidly 
expanding new field of medicine, will enable significant contributions to be 
made to the knowledge of effects on the body of ionizing radiation, and further 
the position of Navy Medicine in this field. 

$ :{£ $ $ sjs sjc 



In the Medical News Letter of 23 October 1959, page 17, the last entry 
of "In Memoriam" should read: CAPT Raymond O. Nickell DC USN. 

* * sj: * # If. 



18 Medical News Letter, Vol. 34, No. 9 



Course in A B C "Warfare Defense 

Title: ABC Warfare Defense, Course #5 

Date: 4-29 January I960. Report prior to Z200, 3 January I960, 

Personnel Office, U.S. Naval Schools Command, Bldg. 28 
Place: U.S. Naval Schools Command, Naval Station, Treasure 

Island, San Francisco, Calif. 
Security 

Clearance: SECRET 

Class Quotas: 50 (10 Army and Air Force; 40 Navy — 30 Medical Corps, 

5 Dental Corps, 5 Medical Service Corps) 

Objectives 

The course is designed for experienced active duty Naval Medical Depart- 
ment officers. Medical aspects of modern warfare and military peacetime oper- 
ations, including problems incident to atomic, biologic, and chemical weapons 
systems, nuclear propulsion, mass casualties, and isotope programs will be 
stressed. Military aspects of weapons systems and military countermeasures 
will be considered also so that Medical officers may function effectively on a 
staff and can reasonably assess medical compromises imposed by the military 
situation. Outstanding speakers, both military and civilian, will be featured on 
the program. Visits will be made to the Navy Radiological Defense Laboratory 
and the Naval Biological Laboratory, and practical exercises and drills will be 
conducted. All students will be supplied texts on a permanent retention basis. 
Eligibility 

1. Medical Corps. Requests for attendance are invited from Medical 
officers. Reserve officers whose attendance would obviously assist them 
in the performance of their duties will be considered, provided they have a 
minimum of 20 months obligated service remaining. 

2. Dental Corps. Officers to attend will be selected by the Bureau. 

3. Medical Service Corps. Requests are invited from senior Medical 
Service Corps officers. Priority will be given to officers assigned duties 
on Fleet and/or District Staffs, and Administrative Officers of Naval Hospitals. 

Interested officers with the above requirements must submit a letter 
request via their Commanding Officers, to reach the Bureau of Medicine and 
Surgery (Attention: Code 316) prior to 15 November 1959. 

TAD orders will be issued to selected candidates. Travel and per diem 
expenses will be charged against Bureau training funds. 

****** 

In the News Letter of 23 October 1959, Vol. 34, No. 8, p. 34, the fol- 
lowing credit line was omitted for article, "Cardiac Stress Two-Step Test, " 
tL. E. Lamb, M. D. , USAF Medical Service Digest, April 1959) 

****** 



Medical News Letter, Vol. 34, No. 9 19 



From the Note Book 



RADM Andrews Reports to Bureau . RADM Cecil L. Andrews MC USN, 
recently appointed to flag rank, has taken over his new assignment as Assistant 
Chief of the Bureau for Personnel and Professional Operations. Prior to report- 
ing to the Bureau he served as Commanding Officer of the U. S. Naval Hospital, 
St. Albans, L. I., New York. (TIO, BuMed) 

CAPT Cell Heads AGARD Committee . CAPT C. F. Gell MC USN, Special Assis- 
tant for Medical and Allied Sciences of the Office of Naval Research, was 
elected Chairman of the Subcommittee on Acceleration and Bio-Assay Tech- 
niques for Human Centrifuges at the recent meetings of the Aeromedical Panel 
of NATO's Advisory Group for Aeronautical Research and Development (AGARD), 
CAPT Gell, U.S. Navy Member of the Panel, attended the meetings in Aachen 
Germany. The Subcommittee will study problems of international standardiza- 
tion of nomenclature and bio -as say end-points for centrifuges. (TIO, ONR) 

CAPT Goodwin Heads Aviation Division . CAPT Merrill H. Goodwin MC USN 
has assumed duty as Assistant Chief of the Bureau for Aviation Medicine and 
Director, Aviation Medicine Operations Division following the retirement of 
CAPT Oran W. Chenault MC USN on 30 September 1959. (TIO, BuMed) 

Stein- Leventhal Syndrome. The Clinical Center of National Institutes of Health 
has launched an investigation of the role of adrenal gland in Stein-Leventhal 
syndrome and has invited the cooperation of intereste&*physicians in referring 
laparotomy-proven cases. Further information on referrals may be obtained 
from Dr. J. F. Rail, Chief, Clinical Endocrinology Branch, National Institute 
of Arthritis and Metabolic Diseases, Bethesda 14, Md. (Washington Report 
on the Medical Sciences, 28 September 1959) 

Yellow Fever, Research at the Armed Forces Institute of Pathology and the 
Army Biological Laboratories at Fort Detrick, Md. , made the unexpected 
discovery that yellow fever virus first strikes not the liver cells, as previously 
thought, but the Kupffer and reticulo -endothelial cells. The finding, reported 
by H. F. Smetana, M.D. , Chief of the Pediatric Branch, AFIP, not only makes 
it possible to diagnose yellow fever during the incubation period instead of a 
week later, but may have significant bearing on the early detection and behavior 
of other virus diseases. (AFIP Letter, 1 October 1959) 

Pamphlets on Alcoholism . A list of pamphlets available on various aspects 
of the problem of alcoholism — for the physician as well as the concerned lay 
person — appears in any of the A.M. A. Archives for September 1959. For a 
small fee these pamphlets may be obtained from the American Medical Assoc- 
iation, Order Department, 535 N. Dearborn St. , Chicago 10, 111. 



20 Medical News Letter, Vol. 34, No. 9 




DENTAL ft K W A I SECTION 



Host Response to Heterogenous Anorganic Bone 

Previous short-term studies have shown that heterogenous anorganic 
bone implants within an osseous bed satisfy two major criteria for a suc- 
cessful transplant — lack of foreign body reaction and subsequent bone union 
with the host. Long-term studies are in process of evaluating whether the 
third criterion, functional reconstruction of the graft, occurs within anor- 
ganic bone implant sites. 

Within a 2 -year period, anorganic bone has been placed in 140 max- 
illofacial bony defects in 10 adult Rhesus monkeys and 42 mongrel dogs, 54 
pulpal applications in 42 dogs, 20 lumbar and 20 lumbosacral spinal fusions 
in 40 dogs, 40 long-bone defects in 20 dogs, and 69 maxillofacial and long- 
bone implants in human patients. All preoperative implant sites were free 
of any apparent infection or visible inflammatory process. Observation at 
30, 60, and 90 days and at one year postoperatively indicated that the rate 
and extent of remodeling in these implants varied with the location, prepara- 
tion, and size of the implant site. 

Implants placed in contact with exposed, bleeding marrow-vascular 
spaces in long bones and vertebral defects exhibited a greater degree of 
remodeling than similar implants placed within the relatively avascular walls 
of sockets and other extraction defects. Residual, trapped, unresorbed anor- 
ganic cortical or spongy chips appeared to be disintegrating in healed, one- 
year postoperative maxillofacial graft sites in adult Rhesus monkeys. Res- 
ponse of pulpal tissues to 200/325 mesh anorganic bone or dentine was similar 
to calcium hydroxide controls. (H. W. Lyon, C.A. Ostrom, F. L. Losee, NMRI, 
Bethesda, Md. ; L.A. Hurley, New York Orthopedic Hospital; P. J. Boyne, 
Marine Corps Base, Twenty-Nine Palms, Calif, , Abstract: J. Dent. Res. , 
July - August 1959) 

sje s[t ;$: ;J< ^ % 

Role of Dentists in Civil Defense 

The role of dentists in civil defense has been defined. For many years, 
civil defense agencies have recommended that, in a major disaster, dentists 
should act as allied medical personnel to assist physicians in the care of the 
injured and, when no physician is at hand, to direct and perform casualty care. 
Under this policy thousands of dentists in all parts of the country have engaged 



Medical News Letter, Vol. 34, No. 9 21 



in first-aid and casualty care training courses to enable them to meet these 
new and unfamiliar responsibilities. Many dentists, however, have questioned 
the propriety of their engaging in such a program and many medical men have 
not subscribed to it. This has given rise to uncertainty and confusion in dental 
civil defense activities. Because casualty care is definitely a medical function 
and any training in the handling of body wounds, excluding the mouth, must be 
given by qualified medical teachers, the concurrence of the medical profession 
is most important. 

Until now, no official pronouncement has come from organized medicine 
approving of such training of dentists or their participation in emergency cas- 
ualty care. However, in fulfillment of a contract with the Office of Civil and 
"Defense Mobilization, the American Medical Association has recently sub- 
mitted to the Office of Civil and Defense Mobilization, Report on National 
Emergency Medical Care. This report, approved by the American Medical 
Association Board of Trustees, is based on the work of a number of Task 
Forces in which representatives of the American Dental Association partici- 
pated. 

Roles of the several allied medical personnel have been defined and 
listed. Among these, recommendations for dentists are stated as follows: 

a. First-aid, including, but not limited to, artificial respiration, 
emergency treatment of open chest wounds, relief of pain, treatment of 
shock, and the preparation of casualties for movement 

b. Control of hemorrhage 

c. Attainment and maintenance of patent airway, and intratracheal 
catheterization to include tracheotomy 

d. Proper and adequate cleansing and treatment of wounds 

e. Bandaging and splinting 

f. Triage of facial and oral injury cases 

g. Oral surgery 

h. Administration of anesthetics under medical supervision 

i. Assisting in surgical procedures other than oral 

j. Insertion of nasogastric tubes to include lavage and gavage, as 

directed 
k. Administration of whole blood and intravenous solutions, as directed 
1. Administration of parenteral medications, as directed 
m. Catheterization of males and females 
n. Administration of immunizing agents, as directed 

Medical Objectives of Disaster Training . In view of the anticipated 
disparity between the number of casualties and the number of physicians who 
will be available, as well as the number of injuries amenable to competently 
administered self-aid and first-aid treatment, subsequent to a mass attack 
on the United States, it is imperative that dentists receive training and become 



22 Medical News Letter, Vol. 34, No. 9 



proficient in the practice of disaster dentistry and, in addition, receive such 
training in disaster medicine as will enable them to take effective lifesaving 
and first-aid measures and to assist the medical profession by performing 
approved additional functions. (Dental News Letter, Office of Civil and Defense 
Mobilization, September 1959) 



NDS Visited by Members of Federation 
Dentaire Internationale 

The U.S. Naval Dental School, NNMC, Bethesda, Md. , was host on 
24 September 1959 to about 70 members of the Federation Dentaire Inter- 
nationale who were visiting dental schools and research centers in the area. 

CAPT E. E. Jeansonne DC USN, Acting Commanding Officer, welcomed 
the group to the Dental School, and introduced RADM C. W. Schantz DC USN, 
Assistant Chief, Bureau of Medicine and Surgery (Dentistry) and Chief, 
Dental Division, Department of the Navy, who greeted the visitors on behalf 
of the Navy Dental Corps. 

The group saw a demonstration of anorganic bone by CDR H. W. Lyon 
DC USN, NMRI, and CAPT D. E. Cooksey DC USN, Head of the Clinical 
Services Department and Head, Oral Surgery Division, U. S. Navy Dental 
School. 

CAPT H.J. Towle, Jr., DC USN, Head, Audio-Visual Department and 
Head, Maxillofacial Prosthetics Division, lectured on the casualty care courses 
taught at the Dental School, and described emergency procedures which can be 
practiced on Mr. Disaster, the manikin developed for casualty care training 
by the Navy Dental Corps. 

The group then toured the Dental School. 

Homelands of the visitors included Austria, Belgium, the British Colony 
of Singapore, England, Finland, France, Germany, Iraq, Italy, Luxemburg, 
The Netherlands, Norway, and Switzerland. 

# =jc * # Jjt $C 

Exhibit Shown at Dental Congress 

The U.S. Navy Dental Corps exhibit, "Dentistry in the Modern Age, v ' 
was shown at the 1959 Mid-Continent Dental Congress in St. Louis, Mo. , 
1-4 November 1959- 

The exhibit was composed of three units and a transilluminated mural 
illustrating modern dental scientific progress. One section of the exhibit 
showed a dental research laboratory in Antarctica; another part illustrated 



Medical News Letter, Vol. 34, No. 9 23 



the use of the TV camera as a medium for training showing dental facilities 
in the Navy, and a TV studio; a third section portrayed several aspects of 
research, including evaluation of implant bone, function of the salivary gland, 
and blood volume studies with the use of radioactive isotopes. 

CAPT J. V. Westerman DC USN, Head, Personnel Branch, Dental Division, 
Bureau of Medicine and Surgery, monitored the exhibit. 

*1* vU Jf -'* \<* *'. 

T *r "T* T •*" T 

Personnel News 

CAPT H. J. Wunderlich DC USNR, Head, Dental Reserve Branch, Dental 
Division, BuMed, recently visited USNR Dental Companies in Pittsburgh, Pa. 
CDR W.A. George DC USNR, Commanding Officer, Dental Reserve Company 
4-10, University of Pittsburgh, acted as host for the visit. CAPT Wunderlich 
met with Reserve Dental officers of Companies 4-2 and 4-10 and Reserve 
Dental officers of the Pittsburgh area. CAPT J. E. Flint DC USNR, is 
Commanding Officer of Reserve Dental Company 4-2. 

CAPT R. B. Wolcott DC USN was elected to the office of President-Elect 
of the American Academy of Gold Foil Operators for the year 1959 - I960. 
CAPT Wolcott is presently on duty at the U, S. Naval Dental Research Facility, 
Administrative Command, U.S. Naval Training Center, Great Lakes, 111. 

CAPT F.T. Wigand DC USN, Head of Oral Surgery Section, Dental 
Service, U.S. Naval Hospital, Jacksonville, Fla, , presented a table clinic 
at the Centennial Session of the American Dental Association in New York City. 
CAPT Wigand is certified by the American Board of Oral Surgery. 

$ $ $ $ $ $ 

Policy 

The U. S. Navy Medical News Letter is basically an official Medical 
Department publication inviting the attention of officers of the Medical 
Department of the Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to medicine, dentistry, 
and allied sciences. The amount of information used is only that necessary 
to inform adequately officers of the Medical Department of the existence 
and source of such information. The items used are neither intended to be, 
nor are they, susceptible to use by any officer as a substitute for any item 
or article in its original form. All readers of the News Letter are urged 
to obtain the original of those items of particular interest to the individual. 

****** 



24 Medical News Letter, Vol. 34, No. 9 




RESERVE lligP 5 ' SECTION 



Transfer to Retired Naval Reserve Without Pay 

Upon application, members of the Naval Reserve may be transferred 
to the Retired Reserve List within the discretion of the Secretary of the Navy. 
The eligibility requirements for such transfer are: 

1. Completion of a total of 20 years of honorable service in any com- 
ponent of the Armed Forces or Armed Force without component. 

Z. Physical disqualification for active duty as a result of a service - 
connected disability regardless of total years of service completed. 

3. Completion of 10 or more years of active Federal commissioned 
service. 

4. Physical disqualification for active duty, not as a result of own 
misconduct, regardless of total years of service completed. 

5. Attainment of age of 37 years with the following provisions: 

a. Completion of a minimum of 8 years of satisfactory Federal 
service subsequent to 1 July 1949, 

b. Completion of a minimum of 8 years of honorable service on 
active duty in time of war or national emergency for at least 6 months; or 

c. Consistent support of the Armed Forces in an outstanding manner 
as determined by the Secretary of the Navy. 

In time of war or national emergency declared by Congress, or when 
otherwise authorized by law, members of the Retired Reserve may be ordered 
to active duty without their consent only when the Secretary of the Navy, with 
approval of the Secretary of Defense, determines that adequate numbers of 
members of Reserve components in an active status are not readily available. 
All retired personnel will keep the Chief of Naval Personnel and the comman- 
dant of the naval district in which they reside informed of any change of address. 

Members of the Retired Reserve are prohibited from wearing the uni- 
form in connection with nonmilitary, personal, or civilian enterprises, or 
activities of a civilian nature. 

A member is normally transferred to the Retired Reserve in the grade 
in which serving at the time of such transfer. There are certain exceptions 
to this rule: 

1. A member who has served satisfactorily in a higher grade than that 
held at the time of transfer will be so transfer red in the higher grade. 

2. Unless entitled to the same or higher grade under (1) above, an 
officer recommended for promotion to any grade under the Reserve Officer 



Medical News Letter, Vol. 34, No.. 9 25 



Personnel Act of 1954, or found qualified for Federal recognition in a 
higher grade, who, at any time prior to promotion is found incapacitated 
for service by reason of physical disability, is entitled, upon transfer to 
the Retired Reserve, to be so transferred in the grade for which recom- 
mended. However, no increase in pay or benefits shall accrue by reason 
of such promotion unless otherwise provided by law. 

3. Unless entitled to the same or higher grade under either (1) or (2) 
above, an officer who has been specially commended by the Head of the 
Executive Department for performance of duty in actual combat for an 
act or service performed prior to 1 January 1947, shall, after his transfer 
to the Retired Reserve, be advanced to the grade next higher than that in 
which he was serving at the time of transfer to the Retired Reserve. 

Requests for transfer to the Retired Reserve should be addressed to the 
Secretary of the Navy via (1) commandant of the naval district in which resid- 
ing and (2) Chief of Naval Personnel. Such request should briefly state the 
reason for making the request and the effective date of retirement desired. 
All retirements become effective on the first day of the month and may not 
be effected retroactively. 

Additional information concerning this subject is contained in BuPers 
Instruction 1820. 2A. 

-A- -JU *J# ^1* kt* tjj 
■f ^ -V«- *v "l" <T» 

Qualifications Questionnaire Revised 

Reserve officers on inactive duty are receiving the Annual Qualifications 
Questionnaire. Distribution of these questionnaires by district commandants, 
CNARESTRA, and area commanders commenced on 1 October 1959. 

A revised form of the questionnaire, NavPers 319 (Rev 1-59), has been 
placed in the supply system to be issued when stocks of the older form, NavPers 
319 (Rev 4-56), are depleted. Officers may receive either the new or the old 
form this year. The new form simplifies the eighth item, 'Military Service. " 

Effective this year, officers will be required to complete the form 
in its entirety every year. Incomplete or "no change 1 ' entries have compli- 
cated the work of selection boards considering officers for promotion to the 
next higher grade, disposition boards considering officers for retention in, 
or release from, the Naval Reserve, and classification analysts reviewing 
officer qualification records. 

When the "quals" questionnaire is received, it is to be filled out in detail 
and returned as soon as possible. It is advantageous to have the record as 
complete and up to date as possible. 

(Naval Reservist, September 1959) 

$ & £ ;Jc 3JC 3£ 



26 Medical News Letter, Vol. 34, No. 9 



/ 




PREVENTIVE MEDICINE 



Eastern Equine Encephalitis 

The New Jersey State Department of Health has reported an outbreak 
of eastern equine encephalitis occurring during the month of September 1959. 
A total of 29 clinically diagnosed cases with 19 deaths have been reported. 
Definite serologic confirmation of diagnosis has been obtained in two cases, 
and in three others the presumptive serologic tests were positive. The 
cases and deaths have been reported from six counties in the southern half 
of the state and have occurred mainly in old persons and the very young. The 
case fatality rate of 65% is not unusual for this type of viral encephalitis. The 
patients have lived in rural wooded areas 5 to 10 miles from the sea coast 
where an increase in mosquito population occurred in August. Species of 
Culex and Culiseta melanura mosquitoes are implicated as vectors. In addi- 
tion to the human cases, infections in horses have been reported, five of which 
were confirmed by isolation of the virus. The disease has also been reported 
to be present in some flocks of pheasants on breeding farms. 

The arthropod-borne (ARBOR) viral encephalitides are a group of acute 
inflammatory diseases of short duration, involving parts of the brain, spinal 
cord, and meninges. Each form of the disease is caused by a specific virus — 
eastern equine, western equine, St. Louis, Venezuelan equine, Japanese B, 
Russian spring -summer, West Nile, Murray Valley, and many others. Severe 
infections usually have an acute onset, high fever, meningeal signs, stupor, 
disorientation, coma, tremors, and spastic, but rarely flaccid, paralysis. 
Mild cases may resemble nonparalytic poliomyelitis. Case fatality ranges 
from 5 to 60%, that of eastern equine and Japanese B types being highest. 
Permanent sequelae are rare except in infants. Specific identification of the 
disease is by demonstration of an increase in antibody titer between early and 
late serum specimens using complement fixation, neutralization, or hemag- 
glutination -inhibition tests. The virus may be isolated from the brain of fatal 
cases. Histopathologic changes are not specific for individual viruses. These 
diseases must be differentiated from encephalitic and nonparalytic forms of 
poliomyelitis; rabies; mumps meningoencephalitis; postinfection or postvac- 
cinal encephalitis; lymphocytic choriomeningitis; bacterial, protozoal, lepto- 
spiral, and fungal encephalitides or meningitides. There is no specific treat- 
ment, nor are isolation, concurrent or terminal disinfections, or quarantine 
indicated. 



Medical News Letter, Vol. 34, No. 9 27 



The source and reservoir of infection in the United States are wild and 
domestic birds. Although serving as hosts, neither horses nor man are im- 
portant reservoirs of infection for types found in the United States. An infect- 
ed mosquito is the immediate source of infection for man except for Russian 
spring -summer encephalitis which is tick-borne. The incubation period is 
usually 5 to 15 days. The virus is not directly transmissible from man to 
man. Susceptibility to the clinical disease is usually highest in infancy and 
old age; inapparent or undiagnosed infection is more common at other ages. 
Infection of any degree apparently results in homologous immunity but not to 
other types. 

Preventive measures are directed toward the elimination of known or 
suspected mosquito vectors through destruction of larvae and adults and their 
breeding places. Screening of living quarters and the use of individual pro- 
tective measures, such as repellents and bed nets, are indicated when the 
disease is present. Vaccines are not recommended for general use. 
(CDRB.F. Gundelfinger MC USN, General Health Practices, PrevMedDiv) 

*A- 'A' •£/> *ff »iU "A- 

#-|V -■ |^ ^|V - ^ --|-» #|*p 

Influenza 1959 - I960 

Specialists of the U. S. Public Health Service and members of the 
Advisory Committee on Influenza Research are agreed that no widespread 
attacks of influenza are presently anticipated. Localized outbreaks of the 
disease undoubtedly will occur during the next several months, however, and 
vaccination is considered a prudent measure. The predominant type of influ- 
enza this fall and winter will probably be the A-Z, or Asian strain, rather 
than Influenza B which was the major form last year. 

The Surgeon General of the Public Health Service, Dr. Leroy E. Burney, 
announced that certain groups in the American public should seriously con- 
sider vaccination before the influenza season begins. 

The following groups were advised to seek medical advice as to their 
need for the vaccine: (1) persons for whom the onset of influenza might 
represent an added health risk, such as individuals with cardiovascular or 
pulmonary conditions, persons over age 55 with chronic illness of any type, 
and pregnant women; (2) persons responsible for the care of the sick; (3) 
persons responsible for providing essential public services, such as law 
enforcement, fire protection, transportation, and communications; and (4) 
industries and other commercial enterprises wishing to keep the employee 
absenteeism rate from rising. (Press Release: Department of Health, 
Education, and Welfare, P.H. S. , October 12, 1959) 

s)c $ s£ ?jt $ s}s 



28 Medical News Letter, Vol. 34, No. 9 



Control of Schistosomiasis in Puerto Rico 

The snail control activity by the Navy in Puerto Rico is almost com- 
pletely confined to the U. S. Naval Station, Roosevelt Roads, which is located 
in a hyperendemic area. Other Navy areas in Puerto Rico and the Caribbean 
either do not have the vectorial snail, or the possibility is considered remote 
that snails are infected with Schistosoma manson i and/or that humans are 
infected from the snail. 

Up to January 1959, the control procedure consisted of inspection for 
the vectorial snail Taphius (Australorbis) glabratus and its control through 
spraying infested water surfaces with sodium pentachlorophenate at the rate 
of 15 pounds per acre of water surface one foot deep (Klock, et al. , 1957). 
This program was uneconomical and inadequate for several reasons, includ- 
ing overdose causing adult snails to leave the water and escape, incomplete 
killing of snail ova, absence of residual agent in water to control snail larvae 
developing from viable ova, and frequent action as a biocide killing much 
beneficial life. A control program with more permanent results was needed. 

Through Dr. F.F.Ferguson, U.S. Public Health Service, several adults 
of the competitive snail, Marisa cornuarietis, which had shown such good 
possibilities as a biologic control in the Quebrada San Anton Watershed 
(Oliver-Gonzalez, Ferguson, 1959) (Medical News Letter, Vol. 33, No. 7, 
3 April 1959) were introduced in the Rio Daguao on the Naval Station. Obser- 
vation indicated that these snails were thriving and multiplying in this water 
course and to all appearances would have no great difficulty in adapting them- 
selves to the ditches and other streams on the Station. Therefore, in March 
the decision was made to set up a rearing pond and to change the character 
of the vectorial snail control program by gradually introducing the competi- 
tive snail Marisa into all fresh water streams and ditches on the Station as 
these snails became available in the rearing pond. 

The pond was made by damming a stream that originated on the Station 
from a spring that apparently flowed the year round. Vegetation of the type 
described by Doctors Oliver -Gonzalez and Ferguson was not natural to the 
site; however, several water weeds and blue -green algae were natural and 
it appeared, in the first month after introducing a few Marisa adults, that 
these food sources were acceptable. Additional adults were then added to 
the rearing pond. It seems fortunate that this pond was started at this time 
as the torrential rains, flooding, and subsequent reduction of the Rio Daguao 
and other water courses on the Station during May and June produced a high 
mortality of Marisa in these water courses. From all appearances, the 
Marisa is a pond snail and there will be difficulty in keeping populations of 
them in water courses that are subject to such conditions as swift currents, 
flooding, and drying. The snails in the rearing pond were not appreciably 
affected by the heavy rains. The rearing pond is being enlarged to accommo- 
date a high production of these competitive snails. Water plants of the genus 



Medical News Letter, Vol. 34, No. 9 29 



Caladium and other pond genera are being introduced into the rearing pond 
to provide a more ample food supply. 

The snail control program for the Station has taken the following form: 

1. Inspection of drainage ditches and other water courses for the pres- 
ence of the vectorial snail, Taphius (Australorbis) glabratus. 

2. Spraying of the water surface of snail infested ditches and streams 
with sodium pentachlorophenate at the rate of 15 pounds per acre of water 
surface one foot deep. 

3. Reinspection two weeks later for the presence of the vectorial snail. 

4. With absence of the vectorial snail, stocking of the ditch or stream 
with competitive snail, Marisa cornuarietis , as a biologic control to oppose 
the return of the vectorial snail. If adults of the vectorial snail are found, 
retreatment (as in item 2. ), reinspection, and stocking. 

Inspections thereafter are made on the basis of once each quarter at 
selected locations in the water courses that originate outside the Station bound- 
aries or are connected to ditches and streams that do, and once every 6 months 
at selected locations in ditches and streams that originate within the Station. 
These subsequent inspections are for the presence of either snail. If the 
vectorial snail is present and the competitive snail is definitely missing, com- 
plete retreatment and restocking is undertaken. If both snails are found, con- 
sideration is given to increasing the number of competitive snails from the 
rearing pond, but no spraying of the water course with molluscacide is done. 
If inspection reveals only the competitive snail or no snails, it is considered 
that control hs been obtained for that period. With ditches originating off the 
Station, emphasis is on quarterly instead of semi-annual inspections because 
these ditch systems are considered much more open to contamination with 
the disease organism and reintroduction of the vectorial snail. 

The Station at Roosevelt Roads has approximately 254, 500 lineal feet of 
drainage, streams, and sea level drains. Of these, approximately 42, 250 
lineal feet are sea level drains of more than 1000 p, p. m. salinity which appar- 
ently is lethal to the schistosoma cercariae (author's observation). Therefore, 
for purposes of control, about 115, 125 lineal feet of water courses are inspect- 
ed at selected locations on a quarterly basis, and 97, 125 lineal feet on a semi- 
annual basis. These inspections are of necessity spread out over the required 
periods. Two "critical" areas of 19, 875 lineal feet combined, one a housing 
area called "120 Houses, " and the other below the housing area at Bundy, are 
inspected monthly and treated or stocked with Marisa as indicated. 

Although well under way, the complete program will not be "fully opera- 
tional" until December 1959. (Report to Puerto Rican Advisory Committee 
for Bilharzia Control: Control of the Vectorial Snail of Schistosomiasis 
(Bilharzia) at Naval Installations in Puerto Rico, W. H. Wymer, Entomologist, 
Area Public Works Office, Caribbean, HDQTRS, 10 ND, San Juan, P. R. ) 



30 Medical News Letter, Vol. 34, No. 9 



Training at Disease Vector Control Center 

Graduation time comes once each month at the Disease Vector Control 
Center (DVCC) NAS, Jacksonville, Fla. Year-round service students on active 
duty or in the Reserve earn diplomas in DVCC's two major pest prevention and 
control courses. 

"Disease Vector Control, " the long established 2-week course, is de- 
signed primarily for Reserve officers of the Civil Engineer Corps, Seabees, 
and Medical Department personnel who request active duty training for 14 days. 

"Disease Vector and Economic Pest Prevention and Control, " a more 
extensive 4-week course, is open to all active duty officers, enlisted person- 
nel, and civilian employees of the Armed Forces who are engaged in supervis- 
ory or actual pest control activities. 

The Two-Week Course . Since its inception in November 1948, over 600 
active duty training Reserves have graduated from the 14-day AcDuTra course 
in "Disease Vector Control. " Reservists are indoctrinated in the latest con- 
cepts of insect vector control with practical applications in utilization of the 
newest insecticides and equipment. 

The first week is spent studying arthropods and insects and basic prin- 
ciples of their prevention and control. The safe application and use of pesti- 
cides is stressed. 

Considerable time is allowed for studying the mosquitoes' importance 
and relation to man as disease vectors and economic pests. Students are 
taught in the laboratory to distinguish different species of larval and adult 
mosquitoes and how to properly use power-driven and hand-operated insecti- 
cide dispersal equipment in control procedures. 

During the second week, students become acquainted with the importance, 
biology, identification, habits, prevention, and control of domestic filth flies 
and deer flies. Ectoparasites, such as ticks, mites, lice, true bugs, and 
fleas are also studied. Other subjects studied are wood-destroying organ- 
isms, such as termites and general household pests, including ants, cock- 
roaches, and silverfish. Lectures are given on poisonous arthropods, rep- 
tiles, and domestic rodents. 

The latter part of the second week, students are taught methods of recog- 
nizing and detecting domestic rodent signs, techniques in rat-proofing and 
stoppage, principles of domestic rodent and ectoparasite prevention and con- 
trol, and importance of domestic rodents as disease reservoirs and destruc- 
tive agents. 

Supplementing study of different types of pests and insects, lectures are 
given on insect resistance to insecticides and effect of insecticides on wildlife. 

The curriculum is concluded with a lecture on vector control in disaster 
and mass evacuation and a practical demonstration in the use of the Vector 
Passive Defense Kit during a possible biologic warfare attack. 



Medical News Letter, Vol. 34, No. 9 



31 



This AcDuTra course is given once every other month except in June 
and August when the curriculum is held twice monthly. The extra courses 
offered during these summer months are provided to accommodate the in- 
creased flow of college and university instructors and students who wish to 
take advantage of DVCC's training facilities during summer recess. 




Students observe demonstration of Hold equipment. 

Newly scheduled dates for convening the 2-week AcDuTra course in 
Disease Vector Control are: 



Fiscal Year I960 



Fiscal Year 1961 



7 Dec through 19 Dec 

8 Feb " 20 Feb 
11 Apr " 23 Apr 

6 Jun " 18 Jun 

20 Jun " 2 Jul 



1 Aug through 13 Aug 
15 Aug " 27 Aug 

10 Oct " 22 Oct 

5 Dec " 17 Dec 



6 Feb through 18 Feb 
3 Apr " 15 Apr 

5 Jun " 17 Jun 

19 Jun " 1 Jul 



Quotas for Navy personnel may be obtained from the approrpiate 
Naval District Commandant. Quotas for other military services may be ob- 
tained from Chief, Bureau of Medicine and Surgery, Department of the Navy. 



32 Medical News Letter, Vol. 34, No. 9 



Washington 25, D. C. Billeting and messing facilities are available at NAS, 
Jacksonville, Fla. 

The Four -Week Course . The four-week curriculum in "Disease Vector 
and Economic Pest Prevention and Control" is a more detailed course pro- 
viding a basic background in pest control. It is designed to assist trainees 
for eventual certification as pest control operators in accordance with Depart- 
ment of Defense directives. Actual certification is accomplished through a 
District Public Works Office upon the recommendation of a Public Works or 
Navy Medical Department entomologist. Since its inception in August 1956, 
this curriculum has graduated over 100 students. 

During the first week, students study the biology and importance of the 
arthropods and, more specifically, the orders of insects and arachnids. Basic 
principles of arthropod prevention are presented with emphasis on the latest 
concepts of arthropod control. 

Because of the importance of chemistry in entomology, the students 
receive an early introduction to various types of insecticides, rodenticides, 
fungicides, herbicides, and wood preservatives. Students are taught the sim- 
plified procedures and calculations for mixing, diluting, and preparing pesti- 
cide liquid, solid, and gas formulations. 

Major emphasis is placed on safe utilization of pesticides as trainees 
consider basic hazards, precautions, and protective measures involved in 
handling, storing, and transporting Standard Navy pesticides. Use of pro- 
tective devices, clothing, and accessories is taught in the classroom and 
demonstrated in the field. 

Through the end of the first week and beginning of the second, students 
study the importance, biology, life cycles, characteristics, habits, identifi- 
cation, and control of such selected household and nuisance pests as the ant, 
cockroach, silverfish, book louse, and such ectoparasites as ticks, mites, 
fleas, bedbugs, conenose bugs, and sucking lice. 

During the second week, students are taught the epidemiology of vector- 
borne diseases. They explore the importance of basic sanitation, learn refuse 
disposal principles and methods, and observe proper construction, operation, 
and maintenance of the sanitary landfill. 

After inspecting the refuse storage, collection, and disposal methods 
aboard NAS, Jacksonville, the trainees are introduced to the operational pro- 
cedures, maintenance, and safety precautions in operating the Tifa, Dynafog, 
Buffalo Turbine, John Bean Power Sprayer, Swing Fog, and Microsol mach- 
ines, and aerial insecticide dispersal equipment. 

As the second week nears its end, students scrutinize the damaging 
effects to food, fiber, and hardwood material made by stored products pests. 

The third week covers extensively all the vector and control aspects of 
mosquitoes and other blood sucking flies, domestic filth flies, rodents, and 
poisonous arthropods, reptiles, and plants. In the final week, topic subjects 



Medical News Letter, Vol. 34, No. 9 33 



and studies, similar to those made on insects, domestic rodents, and rep- 
tiles, are continued on such pest vertebrate animals as the bat, squirrel, 
mole, and other mammals. Fumigation principles, procedures, preparations, 
and safety precautions are introduced and demonstrated to the students, Fum- 
igants such as methyl bromide, "carboxide, " paradichlorobenzene, and cyano- 
gas are studied. Students learn the properties and applications of herbicides 
during the control study on weeds and noxious plants. 

Finally, to complete the course, the last 4 days are spent in the study 
of wood preservation against wood-destroying pests. Control studies are made 
on such wood-eating insects as subterranean and drywood termites, powder 
post beetles, and carpenter ants. 

Newly scheduled dates for convening the basic 4-week course in Disease 
Vector and Economic Pest Prevention and Control are: 

Fiscal Year I960 Fiscal Year 1961 

4 Jan through Z9 Jan 5 Jul through 29 Jul 9 Jan through 3 Feb 

7 Mar " 1 Apr 6 Sep " 30 Sep 6 Mar " 31 Mar 

2 May " 27 May 24 Oct " 18 Nov 1 May " 26 May 

Attendance quotas for this course are allocated and may be obtained from 
the Officer in Charge, Disease Vector Control Center, U. S. Naval Air Station, 
Jacksonville 12, Fla. 

Billeting and messing facilities are available at NAS, Jacksonville, for 
both military and civilian personnel attending the course. 

(DVCC, Jacksonville, Fla.) 

$#$$$$ 

Essentials of Food Establishment Sanitation 

In the two previous articles on this subject (Medical News Letter, 3 July 1959 
and 18 September 1959) the importance of the physical health of food workers 
was stressed, and the necessity for careful scrutiny of food wholesomeness 
was emphasized, respectively. This article, presented as the third in the 
series, discusses refrigeration and cold storage of food. 

Food Refrigeration 

Food refrigeration ranks next to people and food wholesomeness in safe- 
guarding sanitary food quality and public health protection. If perishable foods 
are not effectively held at low cold temperatures, many of the other public 
health precautions which must be taken to protect food will be negated. 

The refrigeration of food has three distinct purposes. The first is pre- 
servation of food by arresting multiplication and proliferation of bacteria in 



34 Medical News Letter, Vol. 34, No. 9 



and on food. Secondly, in food itself metabolic action takes place, but this 
is arrested to a considerable degree in a cold atmosphere. Finally, enzyma- 
tic action is retarded. Both metabolic and enzymatic action have much to do 
with the flavor, nutritive value, and palatability of food. While control in all 
three instances contributes to healthfulness of food, the most important con- 
sideration in terms of food sanitation is that relating to control of bacterial 
growth. Upon this point primarily, food ordinances specify temperature 
limits for the storage of food at low temperatures. 

Temperature Requirements 

While the majority of food ordinances and regulations establish 50° F. 
as the upper limit for the refrigerated storage of perishables, this tempera- 
ture is not sufficiently low for a number of readily perishable foods. To give 
added emphasis to this point, the following examples are given by kinds of 
fresh foods and recommended temperatures. 

Recommended 
Kind of Food Temperature Range ( Q F. ) 

* Vegetables 36-45 

Cured and processed 

meats . 36-40 

Fresh meat 34-38 

Fresh poultry 29-32 

Seafood 

Fresh fish 25-30 

Boiled lobsters 36-40 

Oysters, shucked . . . 23-30 

Fresh milk 40-45 

* Some exceptions are sweet potatoes, spinach, eggplant, celery, 
and endive. In these cases, temperatures up to 55° F. may be 

allowed. 

This abbreviated tabulation emphasizes that the type of food to be refrig- 
erated is a leading factor in determining proper and effective temperature, 
and that a single temperature standard fails to consider the relative perish- 
ability of different kinds and classes of foods. 

Adequacy of Refrigeration 

While temperature requirements form the foundation for proper holding 
and storage of fresh perishable foods, the amount and adequacy of refrigera- 
tion are of almost equal importance. Adequacy has to be judged by a number 
of variables; therefore, it is not possible to say that a food service estab- 
lishment serving "X" number of customers per day will need "Y" cubic feet 



Medical News Letter, Vol. 34, No. 9 35 



of refrigeration space. Some factors which influence the adequacy of refrig- 
eration are: 

1. Type of establishment. That is, table service, cafeteria, lunch 
counter, drive-in, or supper club. 

2. Type of patrons. This will largely determine the size and elabor- 
ateness of the average menu which is a basic factor in establishing min- 
imum refrigeration needs. 

3. Size, seating capacity, and customer turnover during mealtime. 
A quick-lunch counter, where the average turnover per seat is 12-15 
minutes, might be a small establishment in floor area, but would require 
larger refrigeration facilities than a large dining room where patrons eat 
leisurely and the seat turnover during serving periods is relatively light. 

4. Seasonal influx of patrons as in the case of resort restaurants and 
roadside eating places. Refrigeration which is adequate for slow periods 
may be entirely inadequate during "peak" business impact. 

5. Frequency with which food stocks are delivered. Infrequent deliver- 
ies increase the need for larger storage facilities to meet daily service 
requirements. 

With these factors in mind the food sanitarian must evaluate each estab- 
lishment as a separate entity. However, there are some positive signs of 
inadequate refrigeration. One of the most obvious is overcrowding of refrig- 
erator space. If reach-in coolers are used, the disorderly stacking of food 
or the placing of food containers one upon another can usually be taken as a 
sign of space inadequacy. In the case of walk-in refrigerators, the close 
hanging of meat can be taken as a sign that the cooler is too small for the 
amount of meat stored. 

It is common practice to check only the temperature of the atmosphere 
in refrigerators. While this is necessary and important, the use of a special 
thermometer that can be inserted in the stored food itself may be of consid- 
erable assistance in judging both the capacity and efficiency of refrigeration. 
This too is a valuable means of showing the supervisor the necessity of plac- 
ing food masses in low shallow pans rather than in deep stock pots and similar 
containers. Even with an ambient temperature of 40° F. food masses at the 
center remain at incubation temperatures for long periods and provide an 
opportunity for bacterial multiplication. 

The food service establishment supervisor should be instructed on the 
importance of low cold temperatures and the proper use of refrigerator stor- 
age. He should be warned against allowing perishable foods to remain in warm 
rooms. Failure to use refrigeration correctly, overcrowding of coolers, and 
storage of large food masses in deep containers are frequent causes of food- 
borne illness. Because refrigerators are mechanical equipment and subject 
to mechanical failure and deterioration, each one should be equipped with an 
accurate thermometer. A refrigerator may warm to a temperature well above 
40° F. and not be noticed unless there is an accurate thermometer which can 
be checked at regular intervals. 



36 Medical News Letter, Vol. 34, No. 9 



Installation Suggestions 

In most instances, best results will accrue if refrigeration loads are 
divided among units that are operated at or near the same storage tempera- 
ture. Attempting to run both low and high temperature coolers from a single 
condensing unit generally results in higher operating costs per ton of refrig- 
eration. 

Another important point is the quality of the refrigeration unit pur- 
chased. A high quality unit will hold temperatures more uniformly, resist 
corrosion, and be more economical to operate. Small units should have 
aluminum, stainless steel, or other rust resisting surfaces. Floors in walk- 
in coolers should be level with the adjoining floor to permit barrels and heavy 
produce and meat containers to be wheeled in. The refrigerator should be 
lighted so there is 20 to 25 foot candles of light evenly distributed. Shelving 
should be removable to facilitate cleaning. Bins should be on casters to allow 
the floor beneath to be maintained in a sanitary manner. Ultraviolet lights 
have little merit and can in no way take the place of good sanitary practices 
and proper temperatures. 

Refrigeration Regulations 

In preparing a regulation on refrigeration as it applies to the food ser- 
vice business, several considerations may be taken into account. The first 
involves temperature, temperature maintenance, and proper use of facilities. 
It may be difficult to detail all conditions and circumstances surrounding the 
refrigeration of perishable foods. The Manual of Naval Preventive Medicine, 
NavMed P-5010-1, 1-57, contains a table on refrigeration of perishables for 
the guidance of medical department and commissary personnel in computing 
the maximum recommended storage periods for fresh and frozen subsistence 
items under storage or holding temperatures. The following sample regula- 
tion embodies several of the salient points to be considered. 

Refrigerator s 

Adequate refrigerator facilities will be provided all food service facili- 
ties and other food establishments to permit sanitary storage of perishable 
foods. Refrigerators and other cold storage facilities will be kept in a satis- 
factory state of repair and will be equipped with thermometers in working 
order. Storage shelves, meat hooks, food compartments, floor drains, 
et cetera, will be provided in refrigerators and cold storage rooms for the 
sanitary storage of perishables. Handles, doors, and the interior of refrig- 
erators, cold storage rooms, and ice chests will be kept scrupulously clean 
and free from odors. Storage shelves, food compartments, meat hooks, 
et cetera, will be kept clean. Food will not be placed in the same compart- 
ment with ice. No unwholesome food will be placed in refrigerators or cold 
storage rooms. Carcass meat received in bulk (unsliced) will be hung on 
hooks with proper spacing for ventilation. No food will be placed directly on 



Medical News Letter, Vol. 34, No. 9 37 



the shelves and all food containers will be covered. Refrigerator circulating 
and blower units will be kept defrosted. (Special Service Article, Some Essen- 
tials of Food Establishment Sanitation: Journal of Milk and Food Technology, 
22: 117-119, April 1959) 

Rules for Turnpike Driving 

America's high-speed highways — turnpikes — are. responsible for a 
new and extremely dangerous threat to the life of motorists. The threat, 
"highway hypnosis, " claims an increasing number of lives daily. Because 
of traffic in the city, no one worries about road-and-speed hypnosis. How- 
ever, the most skillful city driver faces this new risk on the superhighways. 
To overcome this driving menace, the following rules are suggested: 

KEEP ALERT EVERY MINUTE — note out-of-state licenses; call out 
road signs and town names. 

CHECK YOUR DASHBOARD INSTRUMENTS. Read aloud to yourself 
or to those with you the mileage and speed of travel. Check the gas gauge; 
running out of gas is not only an inconvenience, but a parked car becomes 
another highway hazard for other drivers. 

MAKE SURE YOUR VEHICLE IS IN TIPTOP CONDITION — brakes, 
lights, tires, and windshield wipers. The best of drivers is a menace in 
an unsafe automobile, and garage bills are far less painful than hospital 
costs. 

BE SURE YOU ARE IN GOOD SHAPE YOURSELF. Don't try to drive 
when weariness creeps up; pull off safely to one side of the road and take 
a nap. A simple headache can rob you of the alertness you need for the 
road. 

FOR LONG HAULS, learn the tricks that over-the-road drivers use — 
chewing an oversized wad of gum, sitting on a board, or singing aloud. 

STOP EVERY NOW AND THEN, even when you don't feel tired, and get 
out of the car. Have a cup of coffee, slap cold water on your face, and 
relax for a few minutes. 

WATCH EVERYTHING AROUND YOU. Staring straight ahead is one 
way to slip under the spell of the highway. Look into the car mirrors. 
(For a good driver, a mirror check every five seconds is the rule.) 



38 Medical News Letter, Vol. 34, No. 9 



RELY ON YOURSELF and don't put blind faith in signs and signals. You 
may have the right-of-way, but the other driver may decide to ignore the 
stop sign. A clear conscience is small consolation if you are wrapped in 
a plaster cast. 

GIVE OTHERS A BREAK. Give plenty of warning before changing lanes, 
and don't change lanes except to pass or make a turnoff. 

STAY ALERT ! STAY AWAKE! STAY ALIVE! 

(Nine Rules to Keep You Alive on the Turnpike: Car News and Travel Times: 
1: 5, September 1959) 



Diarrhea of Travelers 

Diarrhea of travelers, widely recognized as a clinical syndrome, has 
been the subject of more speculation than investigation. The study reported 
was designed to determine if any of the enteropathogenic bacteria were res- 
ponsible for the clinical syndrome. Stool samples were obtained for 14 con- 
secutive days from 62 United States students in Mexico. Of these, 27 became 
ill with diarrhea and 35 remained well during the period of observation. 

Salmonella and Shigella were not cultured in any case. Enteropathogenic 
E. coli , Klebsiella and Paracolobactrum could not be incriminated as the cause 
of the diarrhea of travelers to Mexico. {Varela, G. , et al. , The Diarrhea of 
Travelers, II. Bacteriologic Studies of U. S. Students in Mexico: Am. J. Trop. 
M. , 8: 353-357, May 1959) 

****** 

Travel Immunization Revision 

"Immunization Information for International Travel" {PHS pub. #384), 
revised in June 1959 by the Foreign Quarantine Division, Public Health Service, 
Department of Health, Education, and Welfare, reflects changes since June 
1958 in PHS and international immunization requirements and designated yellow 
fever vaccination centers. Copies may be obtained from Bureau of Medicine 
and Surgery, Code 72, or local PHS office. Current changes may be noted in 
"Weekly Morbidity and Mortality Report, " National Office of Vital Statistics, 
or "Foreign Epidemiological Summary, " Foreign Quarantine Division, PHS, 
Dept. of HEW. (CommDisBranch, PrevMedDiv) 

****** 



Medical News Letter, Vol. 34, No. 9 



39 



SPECIAL NOTICE 

Existing regulations have established a fixed number of copies of each 
issue of the Medical News Letter, and require that all Bureau and office 
mailing lists be checked and circularized at least once each year in order 
to eliminate erroneous and duplicate mailings. 

It is requested that EACH RECIPIENT of the News Letter, with the 
listed exceptions, fill in and forward immediately the form appearing below, 
if continuation on the distribution list is desired. Only one answer is necessary. 

(Continued on page 40) 



.{first fold). 



U.S. Navy Medical School 
National Naval Medical Center 
Bethesda 14, Maryland 
Official Business 



Postage and Fees Paid 
Navy Department 



Attention: Code- 18 



To: Bureau of Medicine and Surgery 

Navy Department, Potomac Annex 
Washington 25, D. C. 



PLEASE PRINT OR TYPE (second fold) PLEASE PRINT OR TYPE 

Name or 

Activity 



(last) 



(first) 



(rank - corps - service or civilian status) 

Address (number) (street)_ 

(city) 



(initial) 

Active { ) 

Inactive ( ) 

Retired ( ) 



(zone) (state) 



If more than one copy of each 

issue desired, state number Signature 



(Staple, seal, or paste shut — this flap outside) 



40 



Medical News Letter, Vol. 34, No. 9 



EXCEPTIONS (Reply not required) 

1. All Medical and Dental" Corps officers, regular and reserve on ACTIVE 
DUTY, receiving News Letter at military address 

2. All U.S. Navy Ships and Stations 

Therefore, all others — active duty Medical and Dental Corps officers 
receiving News Letter at civilian address; Nurse Corps and Medical 
Service Corps officers; Ensign 1915 students; inactive personnel, reserve 
and retired; civilian addressees of all categories; foreign addressees; and 
addressees of other U. S. Armed Forces — will please submit the form if 
the News Letter is desired. 

Failure to submit the form by 10 January I960 will result in automatic 
removal of name from the files. PLEASE PRINT OR TYPE. 

Comment or suggestions are invited and appreciated. 

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